{
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"EIN": null,
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"OrgName": "SNAKE RIVER EAR, NOSE & THROAT PC",
"LastName": null,
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"NamePrefix": null,
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"Credential": null,
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"FirstLineMailingAddress": "706 NORTH COLLEGE ROAD",
"SecondLineMailingAddress": "SUITE C",
"MailingAddressCityName": "TWIN FALLS",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83301",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-735-1000",
"MailingAddressFaxNumber": "208-732-5345",
"FirstLinePracticeLocationAddress": "706 NORTH COLLEGE ROAD",
"SecondLinePracticeLocationAddress": "SUITE C",
"PracticeLocationAddressCityName": "TWIN FALLS",
"PracticeLocationAddressStateName": "ID",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-735-1000",
"PracticeLocationAddressFaxNumber": "208-732-5345",
"EnumerationDate": "10/04/2006",
"LastUpdateDate": "01/15/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KACK",
"AuthorizedOfficialFirstName": "ROD",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "208-735-1000",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
"LicenseNumber": "A89785",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}